To download a PDF of this agreement, visit https://www.pfcfmc.org/triple-p

To Whom It May Concern:

I am pleased to welcome you to Triple P (Positive Parenting Program), provided by Partners for Children & Families. It is our goal to provide you with a safe and welcoming space so that together we can connect, explore and address the parenting issues you face and help you feel more confident and competent as the caregiver of your child(ren). Establishing a strong and trusting relationship is important. Your willingness to discuss any concerns with me will support the work that we do together.

During individual sessions where personal situations are shared with me directly, information will be confidential.  During group sessions, confidentiality and respect for one another will be highly encouraged. In all situations, however, I have a duty to report to the appropriate authorities any suspected child abuse, neglect, or dependency.

To prepare for the role of becoming your Triple P coach, I completed the National Triple P training and am now an accredited Triple P Practitioner. I have also completed the Reconnect For Resilience training.   Additionally, I have over 30 years of experience working with young children and their families as an early educator. Please note, I am not a mental health provider and this service is not intended to replace professional therapy or mental health support.
 
Triple P is one of the few parenting programs in the world with evidence to show it works.  I look forward to supporting you and your family during this important time in your lives.

Respectfully,
Diane Atherton
Family Outreach Coordinator & Triple P Practitioner
Partners for Children & Families
(910) 949-4045
datherton@pfcfmc.org
7720 NC Hwy 22
Carthage, NC 28327
www.moore4kids.com

Question Title

* 1. I,_____________________________________, have read this Confidentiality and Disclosure agreement and have been given the opportunity to have any questions answered.

If you would like to participate in this program, please read the statement above and type your full name in the box below:

T